I’ve received some emails (firstname.lastname@example.org) regarding my mention of SCAT5 in Hits to the Head, requesting information about what is involved with this testing. Rather than repeat it individually I thought it a good opportunity to review it here so everyone can read up around this assessment tool. Images for this post have been taken from the British Journal of Sports Medicine.
SCAT stands for Sport Concussion Assessment Tool and was first developed by the Concussion in Sport Group in Prague in 2004. Initially this tool combined assessment of a players symptoms, memory and neurological status to help with assisting medics to review a sports related concussion. The aim was to provide an assessment tool that could be replicated and monitored. Since 2004 when it was first created it has been revised a number of times…..we are now up to SCAT5.
It is designed to be used in patients older than 13years who are suspected of having a traumatic brain injury while playing sport. It should be administered by a doctor as concussion is diagnosed by a constellation of both symptoms, that is patient’s report of how they feel, and signs, the objective findings that the doctor can see. The SCAT5 usually takes only about 10 minutes to administer and during this time the player needs to be off the field in a resting state. It is often useful to have a baseline SCAT5 for all players to allow a comparison of the post head injury score to that when the player was uninjured and therefore determine more accurately the extent to which they have been affected.
Assessment of an injured player usually occurs in two phases. The first component is the immediate on-field assessment designed to assess severity of the initial injury and how the patient should be treated immediately. If the patient is severely unwell they are identified with a red flag identification for immediate transfer to hospital. The SCAT5 is based on observable signs, assessment of memory and use of a well known tool for assessing consciousness, for example the Glasgow Coma Scale. At this step it is also vital that the doctor assesses for a possible neck injury, also known as a cervical spine assessment, as suspected injury in this area would mandate immediate immobilisation and transfer to hospital for further investigations.
The second component of the SCAT5 is made up of an off-field assessment which takes into account the athletes background and their subjective symptoms. This includes cognitive screening to assess memory (immediate and delayed), orientation and concentration. The Doctor then completes a neurological examination including checking the players balance and coordination in addition to a targeted neurological screen. After the full examination is completed the SCAT5 score can be determined based on how well the patient did in each of the individual sections of the test. This score then determines if a concussion is likely, how serious it is and then gives a score as a baseline for monitoring symptoms progression. It is important to note that this tool is just that:- an aid in the management of a concussion. It it not designed to act alone and is designed to be used by the doctor in combination with the overall clinical picture. As a very experienced ED Physician said to me once, “assessment tools should never replace good clinical judgement”.
So you have had a massive head knock and been taken off the field- what advice should you follow? First of all if you have any red flags such as vomiting, seizures, a deterioration in consciousness, restlessness, increasing headache, peripheral weakness in legs and arms, neck tenderness or double vision then go straight to hospital. Even if you don’t notice any of these immediately and you’ve had a head knock you should be carefully monitored by a loved one or friend for the first 24hrs following the injury. If you begin to notice any of these symptoms then you should go to hospital for assessment. If there is no reason to go straight to hospital and SCAT5 testing has indicated that you have a mild head knock then you can go home but there is certain advice that should be followed. Risk of deterioration following mild head injury is small but can and does happen so if you develop any of the red flags you need to go to hospital.
Following any head injury you may develop post concussive symptoms such as ongoing headaches, attention difficulty, fatigue, dizziness, foggy thinking, balance issues, forgetfulness and trouble with memory, anxiety, and reduced alcohol tolerance. These will often resolve over a period of time so long as a stepped approach to recovery as detailed in Hits to the Head is followed. However, in the first 2 days following an injury the patient must rest and avoid physical activity with no driving for 24 hours. Its also important not to take drugs, alcohol or sleeping medications during this time as they can often mask the symptoms of an evolving head injury. When sleeping someone should check in on you every four hours to make sure you are ok. Paracetamol is best for headaches with avoidance of Ibuprofen. As always, if ever you are concerned your GP is always the best person to see to make sure there isn’t nothing serious going on.
Over the next month following a minor head injury adequate sleep is required along with ongoing avoidance of alcohol or drugs. Often relationships may be affected due to increased depressive symptoms or irritability. You may need to have a few days off work as there may be difficulty with concentrating for long periods and the brain needs cognitive rest just as much as physical rest. Your GP can help you determine a recovery plan tailored to your specific symptoms and lifestyle. Finally stepped return to sport is much more important than sudden return which could risk an overlapping concussive episode and an even more prolonged recovery period.